title: Flexible insulin dosing improves health-related quality-of-life (HRQoL): a time trade-off survey.
abstract: OBJECTIVE
  People with insulin-treated diabetes often face strict regimens with inflexible dose timing, frequent injections, and frequent self-measured blood glucose (SMBG) testing. The objective of this study was to estimate the health-related quality-of-life (HRQoL) impact of these aspects using time trade-off (TTO) methods.
  
  
  METHODS
  HRQoL was examined via a TTO survey in the UK, Canada, and Sweden with separate analyses of 2465 respondents from the general population, 274 people with type 1 diabetes, and 417 people with type 2 diabetes. Respondents evaluated health states with diabetes, SMBG testing, and basal injections that were once-daily time flexible, once-daily at a fixed time, and twice-daily at a fixed time in a basal or basal-bolus regimen.
  
  
  RESULTS
  Time-flexible basal injections were associated with 0.016 and 0.013 higher utility vs a fixed time of injection for basal-only and basal-bolus regimens, respectively, as evaluated by the general population. The diabetes respondents confirmed the basal-only results with 0.015 higher utility, but the difference in utility was non-significant for basal-bolus. Once-daily injections had higher utility compared with twice-daily injections for basal (0.039 and 0.042) and basal-bolus (0.022 and 0.021) regimens, as evaluated by the general population and people with diabetes, respectively. Increased frequency of SMBG negatively affected health utility.
  
  
  CONCLUSIONS
  This study has the limitation that it measures hypothetical health states rather than the HRQoL of people with these health states; furthermore, it could be suggested that the web-based nature of this survey is biased towards literate respondents with internet access and IT competence.
  
  
  CONCLUSIONS
  Flexible dosing and fewer injections have a positive HRQoL impact, which potentially may enhance therapy adherence and could contribute to improved long-term outcomes. The impact of flexibility is greater in people treated with basal-only insulin regimens, and diminishes if bolus injections are part of the treatment regimen.
authors.affiliation: Llandough Hospital , Penarth, Cardiff , UK.
authors.forename: Marc
authors.initials: M
authors.lastname: Evans
authors.forename: Henrik Holm
authors.initials: HH
authors.lastname: Jensen
authors.forename: Mette
authors.initials: M
authors.lastname: Bøgelund
authors.forename: Jens
authors.initials: J
authors.lastname: Gundgaard
authors.forename: Barrie
authors.initials: B
authors.lastname: Chubb
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Khunti
mesh_terms: D000293:Adolescent; D000328:Adult; D015190:Blood Glucose Self-Monitoring; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000523:psychology*; D004334:Drug Administration Schedule; D005260:Female; D006304:Health Status; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D011788:Quality of Life; D013997:Time Factors; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin